# Children's Migraine Hides Behind Stomach Aches
Abdominal pain in children is one of the most common complaints that bring parents to the pediatrician. But what if recurring episodes of abdominal pain are not caused by a stomach virus, a poorly tolerated food, or pre-school nerves? What if the real culprit is migraine? This idea may sound surprising, but experts are confirming it ever more loudly – and many families know it from their own experience without even realising it.
Migraine is firmly associated in the public mind with adults lying in a darkened room with a hand over their eyes, unable to tolerate even the slightest sound. In children, however, this condition manifests in an entirely different way, which is precisely why it goes unnoticed for so long. Instead of a headache, a wave of nausea arrives, along with vomiting and cramping pain around the navel. The child looks pale, refuses to eat, wants only to lie down – and an hour or two later is as good as new. Parents breathe a sigh of relief, the paediatrician records "non-specific abdominal pain," and the cycle starts all over again a few weeks later.
Try our natural products
Abdominal migraine: a hidden diagnosis with a clear face
The medical world knows this phenomenon as abdominal migraine and the International Headache Society has classified it as an officially recognised diagnosis since 2004. Despite this, it remains underdiagnosed in practice. It is estimated that approximately 1 to 4 percent of school-age children suffer from abdominal migraine, with girls affected slightly more often than boys. Episodes most commonly occur between the ages of four and twelve, and in a large proportion of children they gradually transition into classic migraine with headache in adulthood.
The key feature of abdominal migraine is its episodic nature. Pain comes in attacks that typically last between two and seventy-two hours, with the child completely free of symptoms in between. The pain is moderate to severe, localised around the navel or in the central abdominal area, and is usually accompanied by nausea, vomiting, loss of appetite, and pallor. Some children also report sensitivity to light or noise – symptoms that most reliably point doctors in the right direction.
For a diagnosis to be established, the attacks must meet precise criteria – among other things, they must have occurred at least five times, must not be explainable by another cause, and must include at least two of the accompanying symptoms mentioned above. Diagnosis therefore requires time, careful observation, and above all a doctor who considers this possibility. The International Classification of Headache Disorders (ICHD-3) is a valuable guide in this regard, not only for specialists but also for curious parents.
Imagine a family in which ten-year-old Tereza has been suffering from episodes of abdominal pain since the age of six. Her parents have undergone dozens of investigations – ultrasound scans, blood tests, coeliac disease screening, allergy tests. Everything came back normal. It was only a new paediatric neurologist who noticed that the episodes always came after significant stress or after sleeping in late, that Tereza's mother suffered from classic migraine, and that the girl looked completely healthy between attacks. A diagnosis of abdominal migraine changed the entire approach to treatment – and the attacks were significantly reduced.
What triggers childhood migraine and what it is like to live with it
The triggers of childhood migraine are surprisingly similar to those in adults. They include irregular sleep patterns, skipping meals, dehydration, significant stress, or conversely the release of tension after a stressful period – the so-called "weekend attacks." Certain foods also play a role, such as chocolate, cheese, processed meat products, or foods containing monosodium glutamate. In more sensitive children, strong smells, flashes of light, or changes in weather can also trigger an attack.
Family history is one of the strongest risk factors of all. If one parent suffers from migraine, the probability that a child will also have it is approximately fifty percent. If both parents suffer from migraine, the probability rises to as high as seventy percent. Migraine is therefore a largely genetically determined condition, which is precisely why family history should always be one of the first questions asked when investigating unexplained abdominal pain.
But how does one actually live with this diagnosis? The treatment of abdominal migraine operates on two levels. The first is acute management of an attack – rest, darkness, adequate fluids, and if necessary, medication to relieve pain or nausea. In older children, triptans may be prescribed following consultation with a doctor; these are the standard of migraine treatment in adults and their use in paediatrics is gradually expanding. The second level is a preventive approach, meaning efforts to minimise triggers and, where appropriate, prophylactic medication for children with frequent or severe attacks.
Non-pharmacological preventive measures can be surprisingly effective. A regular daily routine – getting up at the same time even at weekends, eating at regular intervals, adequate fluid intake, and limiting screen time before bed – these are the fundamental pillars discussed by both neurologists and paediatricians. The World Health Organization WHO has long emphasised that sufficient sleep and physical activity are key factors in children's health in general, and for children with migraine this is doubly true.
The psychological wellbeing of the child also plays a considerable role in the overall picture. Anxiety and chronic stress are very common in children with migraine – and the relationship runs in both directions. Stress triggers attacks, but the attacks themselves are stressful for the child. Missed school days, the inability to plan activities, the feeling of being different from peers – all of this can deepen anxious tendencies in sensitive children and create a vicious cycle that is difficult to break without professional help. A child psychologist or psychotherapist specialising in somatic complaints can be just as valuable in such cases as a neurologist.
How parents can help and when to seek a specialist
One of the most practical tools available to parents is a pain diary. Recording attacks – when they occurred, how long they lasted, what preceded them, what the child ate, how they slept – can reveal patterns over the course of a few months that are not immediately apparent. This diary then becomes an invaluable resource for the doctor and can significantly shorten the time to a correct diagnosis. There are also apps designed specifically for tracking migraine in children, such as Migraine Buddy, which is available in Czech.
So when is it time to stop waiting and seek a specialist? The answer is clear: if episodes of abdominal pain recur without an obvious cause, if they are accompanied by pallor, nausea, or sensitivity to light, and if the child appears completely healthy between attacks – a consultation with a paediatric neurologist is warranted. A paediatrician may be the first step, but abdominal migraine is a diagnosis that deserves a specialist.
As leading British paediatric neurologist Andrew Hershey has noted: "Migraine in children is a chronic condition that significantly affects the quality of life of the entire family – and yet it remains one of the least recognised childhood diagnoses." These words apply as much in the United Kingdom as in the Czech Republic, where access to paediatric neurology continues to be hampered by a shortage of specialists and long waiting times.
It is also important to clarify what abdominal migraine is not. It is not an invention of oversensitive parents. It is not a sign that the child does not want to go to school (even though school-related stress can be a trigger). It is not an allergy or coeliac disease, although these conditions must be ruled out. And it is certainly not something a child will "grow out of on their own" – without proper care, it can progress to a chronic form and significantly affect the entire childhood and adolescence.
Parents who encounter the diagnosis of abdominal migraine for the first time often describe a strange mixture of relief and surprise. Relief that they finally have a name for what has been troubling their child. And surprise at how long it took for someone to consider this possibility. This is precisely why raising awareness in this area is so important – the more parents, teachers, and doctors know about abdominal migraine, the sooner the correct diagnosis can be made, and the less unnecessary suffering the child will endure.
A healthy lifestyle, a regular daily routine, quality sleep, and a mindful approach to nutrition are not merely fashionable topics – for a child with migraine, they are literally tools that determine whether an attack will occur or not. And that is good news: families genuinely have a large part of what influences childhood migraine in their own hands.
